Initial Herbal Consultation Questionnaire Form

If you are interested in submitting a request for online herbal consultations, please submit the form below.  Our fee is $35.00 per herbal consult.  Please note that this is not a guarantee that we will provide services to you for your particular health issues.  There are limitations to what can be accomplished online and if our Chinese Medicine practitioners feel you are not a good fit for online consulting services we will tell you (before you are asked to pay).

After submitting your form, if approved for herbal consultations, you will be sent an invoice through which you may pay online for the herbal consultation.

After receiving payment we will send a longer set of questions.  Your payment will cover our initial request for more information and, after your followup, our recommendations.  Further consults will require additional payment.  

Please note, that you are not required to purchase any of the herbal products from us, but we cannot recommend dosages or herbal formulas other than what we offer in our store.

Consults are directed by Chad J. Dupuis, a licensed acupuncturist in Tennessee and Georgia with over 15 years of clinical experience and the principal practitioner and founder of the Yin Yang House.

If you have tried other modalities, have tried or are currently on any medications for the issues above and/or any natural remedies, please describe them below.

Tongue diagnosis is an important part of the Chinese Medicine diagnostic process. If possible, please take a picture of the surface of your tongue in natural lighting (without a flash) and upload it from your computer below.

By submitting this form you agree to online herbal consultations by our Chinese Medicine practitioners via email. You agree that online consultations are an uneven substitute to physical consultations and realize that our recommendations are offered as just that – recommendations. You have no obligation to purchase anything from us or any other supplier. You agree to release our practitioners, Chinese Herbal Medicine .today and Yin Yang House Inc from any and all liability due to your use of herbal medicine or other products we offer. This agreement begins when you submit this form and stays intact through any and all subsequent contact. Our privacy policies are offered on our store policies page.